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Updated: Aug 5, 2025
Measurement of Liver Stiffness Using Atomic Force Microscopy Coupled with Polarization Microscopy
Published on: July 20, 2022
Predicting Post-hepatectomy Liver Failure Preoperatively for Child-Pugh A5 Hepatocellular Carcinoma Patients by Liver
Jiayao Huang1, Haiyi Long1, Jianyun Peng1
1Department of Medical Ultrasonics, Sun Yat-Sen University First Affiliated Hospital, No. 58, Zhongshan Road II, Yuexiu District, Guangzhou, 510080, Guangdong, China.
Insights
Liver stiffness (LS) measured by 2D-SWE can predict post-hepatectomy liver failure (PHLF) in hepatocellular carcinoma (HCC) patients with Child-Pugh score 5. A model combining LS and future liver remnant (FLR/eTLV) effectively predicts PHLF risk.
Area of Science:
- Hepatobiliary Surgery
- Oncology
- Medical Imaging
Background:
- Post-hepatectomy liver failure (PHLF) is a major cause of mortality in hepatocellular carcinoma (HCC) patients undergoing liver resection (LR).
- Child-Pugh (CP) score 5, typically indicating normal liver function, includes patients at risk for PHLF.
- Predicting PHLF in this subgroup is crucial for patient management.
Purpose of the Study:
- To evaluate the efficacy of liver stiffness (LS) measured by two-dimensional shear wave elastography (2D-SWE) in predicting PHLF.
- To assess the predictive capability of LS for PHLF in HCC patients with a CP score of 5.
Main Methods:
- 146 HCC patients with CP score 5 undergoing LR were analyzed.
- Patients were divided into training (n=97) and validation (n=49) cohorts.
- Logistic analysis identified risk factors; a linear model incorporating LS and FLR/eTLV was developed to predict PHLF.
Main Results:
- Minimum LS (Emin) > 8.05 and FLR/eTLV were independent predictors of PHLF (p<0.01).
- The combined model achieved an AUC of 0.78 in the training group and 0.76 in the validation group.
- These findings indicate a significant association between LS and PHLF development.
Conclusions:
- Liver stiffness is a valuable predictor of PHLF in HCC patients with CP score 5.
- A predictive model integrating Emin and FLR/eTLV demonstrates good performance in identifying patients at risk for PHLF.
Background:
Post-hepatectomy liver failure (PHLF) represents the major source of mortality after liver resection (LR) in hepatocellular carcinoma (HCC) patients. Child-Pugh (CP) score 5 is always considered to indicate a normal liver function but represents a heterogeneous population with a considerable number suffering from PHLF. The present study aimed to access the ability of liver stiffness (LS) measured by two-dimensional shear wave elastography (2D-SWE) to predict PHLF in HCC patients with a CP score of 5.
Methods:
From August 2018 to May 2021, 146 HCC patients with a CP score of 5 who underwent LR were reviewed. The patients were randomly divided into training (n = 97) and validation (n = 49) groups. Logistic analyses were conducted for the risk factors and a linear model was built to predict the development of PHLF. The discrimination and calibration were assessed in the training and validation cohorts by the areas under the receiver operating characteristic curve (AUC).
Results:
Analyses revealed that the minimum of LS (Emin) higher than 8.05 (p = 0.006, OR = 4.59) and future liver remnant / estimated total liver volume (FLR/eTLV) (p < 0.001, OR < 0.01) were independent predictors of PHLF in HCC patients with CP score 5, and the AUC calculated by the model based on them for differentiation of PHLF in the training and validation group was 0.78 and 0.76, respectively.
Conclusion:
LS was associated with the development of PHLF. A model combining Emin and FLR/eTLV showed proper ability in predicting PHLF in HCC patients with a CP score of 5.
